Killing off measles with two shots

Most of us who went to school in India before the 80s are familiar with measles and the high fever, rash and cough that come with it. Almost all schools had sporadic outbreaks caused by a ‘patient zero’ whose parents had no idea that their child had turned into an efficient infection machine that could sicken anyone who came within talking distance.

Each person with measles infects nine out of 10 people without immunity against the infection. Three decades ago, when vaccines were rare and the only way most children developed immunity against measles was getting infected, all you could do was suffer the painful rash you were forbidden to scratch.

Vaccination against measles is a part of routine immunisation the world over, but the infection continues to kill 1.58 lakh children each year. Almost all are under the age of 5, which means 430 children die of measles-related complications each day.

They could have been saved with two doses of a safe, effective and inexpensive vaccine that’s been around since 1971.

The World Health Organisation (WHO) recommends that children get two doses — the first when they are 9 months old and the second dose between 12 and 15 months — of MMR vaccine that protects against measles, mumps and rubella (German measles). Two doses offer lifetime protection, with antibody titers well above the minimal limits up to 16 years after vaccination.

This vaccine is largely credited with the global fall in measles deaths by 71% — from 5.42 lakh to 1.58 lakh — between 2000 and 2011, the last year for which data is available. Over the same period, new cases more than halved from 8.53 lakh in 2000 to 3.55 lakh in 2011, showed WHO data released this year.

Most children just suffer from symptoms of high fever, running nose and that appear 10 days after infection, followed by a rash that appears over the face and rapidly extends down to cover the whole body over the next three days. Malnourished children – 46% children in India are underweight and 38% stunted — with a weakened immunity to begin with are at risk of ear infections, pneumonia, encephalitis, and even death.

Measles was eliminated from developed countries in 2002, but risk remains, with this year being among the worst in terms of global outbreaks. The US has recorded the highest measles in over a decade, from a low 37 in 2004 to 220 this week. One ‘patient zero’ was a man from Colorado who travelled to India, went back home and infected several others in his home town clinic between May 25 and May 27.

The UK reported more than 1,400 cases, mainly due to an accumulation of children who weren’t vaccinated when they were babies because of a now completely discredited research published in The Lancet in 1998.

In other parts of the world, children are missed because of bad infrastructure and sheer ignorance. Most often, the vaccines don’t reach them, and when they do, parents don’t know the importance of getting their child the shot in the arm. Of the 2 crore children worldwide who did not get vaccinated even once, a third (67 lakh) lived in India.

Like polio, measles is highly infectious and at least 95% children need two doses of the vaccine to ensure there are no outbreaks. About 15% of vaccinated children do not develop immunity from the first dose, which means outbreaks can happen even if only 80% are fully immunised.

This month, India completed the third phase of a massive polio-style measles three-phase vaccination campaign that covered more than 118 million children in 344 districts across 14 states, achieving between 87% and 90% coverage. ‘Catch-up’ campaigns were done in areas where first-dose coverage was less than 80%.

Due to its sheer size, population density, migration, and pockets of low routine immunisation coverage, India is likely to have ongoing measles outbreaks unless the government piggybacks on the polio campaign to reach two doses of the vaccine to every child.